Abstract

PURPOSE: Thoracic Percutaneous Needle Aspiration (TPNA) and core needle biopsy (CNB) are common and safe procedures performed either by interventional radiologists or pulmonologists. Few pulmonary training programs offer training in TPNA.The purpose was to compare the yield and complications of TPNA/CNB when the procedure is performed by pulmonologist versus interventional radiologist.

METHODS: Retrospective review of records of patients that underwent TPNA/CNB from 2004 to 2006. At our institution the procedure is done either by a single radiologist or any of four pulmonologist supervising the fellows.

RESULTS: We identified 31 patients, mean age 61 years, 18 and 13 in the Pulmonary and Radiology group respectively. There were more patients with COPD and HIV infection in the pulmonary group; this was statistically significant (p 0.002). There were no differences for radiological characteristics,diagnostic yield or complications between the groups. Table 1 The yield was 50% in the Pulmonary versus 69% in the Radiology group. Malignancy was the most common diagnosis found. CNB was used in 22% and TPNA-only in 78% of pulmonary cases versus 54% and 46% for radiology; the difference was not significant. Table 2. A pathologist was present in the room only for pulmonary cases.

CONCLUSION: The diagnostic yield was similar in both groups. There was a trend for radiologist to have a higher yield; this could be due to expertise obtained by a single operator doing larger number of cases as well as special training in TPNA/CNB. In our study, the presence of a pathologist in the room did not increase the yield of the procedure.

CLINICAL IMPLICATIONS: Pulmonary fellowship programs that want to offer training in TPNA/CNB should develop a mechanism to achieve a minimum competencies in the procedure, this could mean limiting the number of faculty performing it or teaming with radiologist to train the pulmonary residents. Obtaining expertise in CNB is of the outmost importance to maximize yield of the procedure and decrease the need for further invasive diagnostic procedures.

Return to: COMPARISON OF THE YIELD OF THORACIC PERCUTANEOUS NEEDLE ASPIRATION AND CORE BIOPSY BETWEEN PULMONOLOGIST AND RADIOLOGIST IN AN INNER CITY HOSPITAL

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